EmailMe Form - Credit Card Authorization Form

EmailMeForm

Traveller 1
Cardholder Name *
First Last
Legal name as on government issued identification.
Date of Birth *
MM / DD / YYYY
Please enter Date of Birth for Primary Passenger
Billing Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Please enter the address that is on file with the card.
Email *
This will be used for mailing any electronic documents/itineraries.

Confirm
Please List All Travelers Legal Names to be included on this reservation (same room).
Full Legal Names Birthdate MM/DD/YY format of all passengers residing in the same room.
Authorized Amount *
$ Dollars . Cents
The amount of a 25% MINIMUM DEPOSIT is required today to initiate reservation.
Credit Card (VISA or MASTERcard)

Card Number

Protected in vault Data collected via fields that have our security seal are encrypted and stored with the highest global security standard — PCI compliance. Your data is absolutely safe in Vault.
Authorization of Charges *
I do authorize
As named Cardholder; I Authorize: Hotel Entre Dos Aguas, to immediately charge 25% of the reservation to my credit card, as needed to secure the reservation.
Authorization of Future Payments *
I Authorize my Future Payments
I authorize the hotel to charge the remaining balance of the full booking amount in case of no-show or cancellation, in accordance with the booking and cancellation policies.
Cancellation Policies *
I agree that it is my responsibility to purchase travel insurance or make necessary arrangements in case of a now-show. In case of cancellations made 50 days prior to the arrival date there is a full refund of the deposit. For cancellations made less